BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  August 19, 2015


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                                 Jimmy Gomez, Chair


          SB 319  
          (Beall) - As Amended July 7, 2015


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          |             |Health                         |     |19 - 0       |
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          Urgency:  No  State Mandated Local Program:  YesReimbursable:   
          No


          SUMMARY:  This bill expands the duties of the foster care public  
          health nurses to include monitoring and oversight of the  
          administration of psychotropic medication to foster children, as  
          specified. Specifically, this bill: 










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          1)Authorizes a provider of health care to disclose medical  
            information to a foster care public health nurse to coordinate  
            health care services and medical treatment for a minor who has  
            either been taken into temporary custody, had a petition filed  
            with the court, or been adjudged a dependent child or ward of  
            the juvenile court, as specified.


          2)Requires the foster care public health nurse and the child's  
            social worker to consult, collaborate, and share information  
            in a timely manner to ensure that the child's physical,  
            mental, dental, and developmental needs are met. 

          3)Requires that a foster care public health nurse have access to  
            a child's medical, dental, and mental health care information  
            in order to allow that nurse to fulfill his or her duties.


          4)Requires a foster care public health nurse, at the request of  
            a nonminor dependent, to assist him or her in making informed  
            decisions about his or her health care by, at a minimum,  
            providing educational materials.


          5)Adds to the duties of a foster care public health nurse the  
            monitoring of each child in foster care who is administered  
            one or more psychotropic medications, as specified.





          FISCAL EFFECT:


          1)Ongoing costs of approximately $12 million ($3 million GF) to  
            DCHS for public health nurses to collaborate with social  
            workers and to monitor, review and document information  
            related to the administration of psychotropic medications,  








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            assuming an average caseload of 1:200.


          2)Ongoing non-reimbursable costs of approximately $6 million  
            ($4.85 million GF) for county social workers to consult,  
            collaborate and share information with foster care public  
            health nurses. (Proposition 30 exempts the State from mandate  
            reimbursement for realigned programs, however, legislation  
            that has an overall effect of increasing the costs already  
            borne by a local agency for realigned programs, including  
            child welfare services, apply to local agencies only to the  
            extent that the State provides annual funding for the cost  
            increase.)


          3)Onetime costs of $45,000 ($22,000 GF) and ongoing costs of  
            $7,000 ($3,500 GF) to DHCS to develop curriculum and train  
            public health nurses.


          COMMENTS:


          1)Purpose. This is one of four bills proposing a set of reforms  
            aimed at curbing excessive and inappropriate authorization and  
            administration of psychotropic medications among foster youth.  
             The author states that nearly one in four foster children and  
            56 percent of children in group homes are receiving  
            psychotropic drugs, often without adequate oversight. The  
            author further states that without adequate oversight, these  
            medications can cause irreversible damage, and many youth  
            experience long-term side effects, including diabetes, heart  
            disease, irreversible tremors, tics, weight gain and  
            drowsiness. This bill utilizes public health nurses to oversee  
            the medical monitoring of psychotropic drugs to increase  
            oversight and reduce the number of children prescribed these  
            drugs.

          2)Background. AB 1111 (Chesbro), Chapter 147, Statutes of 1999,  








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            required DSS to establish a program of public health nursing  
            within the child welfare services program. This program - the  
            Health Care Program for Children in Foster Care- is located in  
            county child welfare agencies and probation departments, and  
            serves to assist in meeting the medical, dental, mental  
            health, and developmental needs of foster youth. 



            Foster care public health nurses work with child welfare  
            caseworkers and probation officers to promote access to  
            comprehensive health services.  Federal funding requirements  
            stipulate that the services provided by foster care public  
            health nurses must be limited to health-related case  
            management and not involve the provision of direct health care  
            services.  Under the supervision of supervising public health  
            nurses, foster care public health nurses consult and  
            collaborate with social workers and probation officers to  
            provide services such as: medical and health care case  
            planning; expediting referrals for medical, dental, mental  
            health and developmental services; and helping to develop and  
            maintain each child's Health and Education Passport, which  
            provides a summary of all obtainable health and education  
            information for foster youth that travels with each youth  
            throughout out-of-home placement. According to the County  
            Welfare Directors Association of California, there are  
            approximately 250 foster care public health nurses working  
            throughout the state.


            Research has repeatedly indicated that children and youth in  
            foster care face higher levels of inappropriate or excessive  
            medication use, and that those foster youth placed in group  
            home settings are particularly vulnerable to over-prescription  
            and misuse of psychotropic medications.  Data provided by the  
            Department of Health Care Services (DHCS) indicate that, in  
            fiscal year 2013-14, almost 15% of all foster youth in  
            California ages 0 to 20 years old were prescribed at least one  
            psychotropic medication; for foster youth ages 12 through 20,  








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            this rate was almost 25% and for youth placed in group homes,  
            it was 50%.

          3)Related Legislation. The following bills are part of a  
            four-bill package (including this bill) regarding the use of  
            psychotropic medication for children in foster care. All are  
            before this Committee today.



             a)   SB 238 (Mitchell), 2015, requires DSS to develop  
               expanded training for foster parents, social workers, group  
               home administrators, and others involved in the care and  
               oversight of dependent children on issues related to  
               psychotropic medications.  


             b)   SB 253 (Monning), 2015, modifies juvenile court  
               practices and requirements regarding the authorization of  
               psychotropic medications for foster youth by, among other  
               things, requiring clear and convincing evidence that  
               administration of the medication is in the best interest of  
               the child and, in specified circumstances, prohibiting the  
               authorization of psychotropic medication administration for  
               a child unless a second opinion is obtained from a child  
               psychiatrist or behavioral pediatrician.


             c)   SB 484 (Beall), 2015, requires DSS to compile and post  
               on its Internet Web site specified information regarding  
               the administration of psychotropic medications to children  
               placed in group homes and to establish a methodology for  
               identifying group homes with high levels of psychotropic  
               drug use.  Further establishes certain requirements for  
               those group homes.


          









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          Analysis Prepared by:Jennifer Swenson / APPR. / (916)  
          319-2081